title: Distal ulnar-basilic fistula as the first hemodialysis access.
abstract: OBJECTIVE
  A distal forearm ulnar-basilic (UB) arteriovenous fistula (AVF) can be chosen if a radial-cephalic (RC)-AVF is not suitable for a primary AVF. However, limited data are available on the feasibility of using a distal forearm UB-AVF as an option for primary AVF.
  
  
  METHODS
  This retrospective analysis included 446 patients for whom AVFs (417 RC and 29 UB) had been newly created from January 2003 to December 2009, at our hospital. Patients in whom the arterial or venous anatomy precluded RC-AVF creation, UB-AVF was established as distally as possible on the forearm. Patency, defined as access survival after creation, was calculated using Kaplan-Meier analysis. The difference in patency between the two groups was examined using log-rank test.
  
  
  RESULTS
  The primary patency of UB-AVFs was significantly lower than that of RC-AVFs (p=0.037, log-rank test). The primary patency rate at 1 year was 25.0% versus 44.7%, respectively. However, there was no significant difference in secondary patency between the two groups. The secondary patency rate at 1 year was 85.5% for UB-AVFs versus 82.9% for RC-AVFs. The incidence rate of percutaneous angioplasty until access abandonment per patient-years was 1.100 for UB-AVFs versus 0.671 for RC-AVFs. There was no difference in the time to maturation between the two groups.
  
  
  CONCLUSIONS
  The secondary patency rate of UB-AVF is similar to that of RC-AVF. We recommend the creation of an UB-AVF when an RC-AVF is not a suitable option for the primary AVF.
authors.affiliation: Department of Artificial Organs, Tsuchiya General Hospital, Hiroshima - Japan.
authors.forename: Sadanori
authors.initials: S
authors.lastname: Shintaku
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawanishi
authors.forename: Misaki
authors.initials: M
authors.lastname: Moriishi
authors.forename: Masataka
authors.initials: M
authors.lastname: Bansyodani
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tsuchiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency; D055815:Young Adult